The Support of Military Caregivers – Options for action for Congress

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There are currently 5.5 million men and women in the United States who assist a current or former employee with a disabling injury or illness. We call these men and women military caregivers. They are our country's unsung heroes: their support keeps veterans out of institutions and helps them live longer and better lives.

All sectors of society can help ease the burden on military caregivers. The federal government has an important role to play: Congress, in particular, has already created policies and promised programs to support caregivers. However, our research has highlighted gaps between the needs of military caregivers and the support currently available to them. Below, we highlight additional ways in which federal legislation can help fill these gaps.

Fully fund the Lifetime Leave Act

The amount of time a person spends per week caring for others is associated with an increased risk of negative outcomes, such as depression. One way to reduce this burden is to offer caregivers temporary leave. Short-term respite care provides short-term respite care. Unfortunately, there are few temporary care services for military caregivers. Currently, only ten organizations (mostly private and non-profit) provide temporary care specifically for military nurses, leaving many without such services.

In 2006, the Respite Care Act (P.L. 109-442) was enacted, which authorized Congress to provide approximately $288 million between 2007 and 2011 to provide affordable, quality respite services to caregivers. However, Congress did not appropriate the funds until 2009, and since then the program has received only $2.5 million annually, leaving some states with about $200,000. Full funding of the program would allow for expanded temporary services for military nurses, thereby reducing the burden on military nurses.

Caregiving comes at a price:

Caregivers have worse mental and physical health than others; military caregivers are nearly five times more likely to be depressed and have significantly worse health than other caregivers.

Military caregivers are more dissatisfied with their family and marital relationships than other caregivers.

Caregivers who try to juggle caregiving and work miss many hours of work, resulting in personal financial strain and lost productivity for employers (post-9/11, the cost of lost productivity for caregivers is about $5.9 billion per year).

Learn about the eligibility criteria for caregiver support programs

Eligibility for most caregiver support programs is determined by two factors: the age of the caregiver (most programs are for people age 60 and older) and the relationship between the caregiver and the person being cared for (most programs only apply to close relatives).

However, more than 80% of those who served in the military after 9/11 are under age 60, making their caregivers ineligible in some states for benefits such as the National Family Caregiver Support Program and Medicaid home and community-based services waivers.

In addition, nearly one-third of these post-9/11 caregivers are cared for by family and friends, and these caregivers are ineligible for programs intended only for loved ones (such as the VA's Caregiver Support Program). Legislation to expand eligibility for these programs to military caregivers could help address gaps in access to care.

Make sure military caregivers have health insurance

Prior to September 11, 2001, 20% of military nurses were uninsured, and after September 11, 2001, nearly 40% were uninsured. Health insurance is vital to caregivers' well-being and helps them continue to care for veterans.

Currently, immediate family members of retired veterans must obtain coverage through TRICARE; military caregivers who are enrolled in the Veterans' Comprehensive Family Caregiver Assistance Program, but are otherwise uninsured, receive coverage through CHAMP-VA.

Otherwise, military caregivers have the same options as civilians: they can obtain coverage through their employer, the newly created health exchange, Medicaid (for households with less than 133% FPL, which covers about 20% of military caregivers), or Medicare (for those 65 and older). Targeted training and outreach may be needed to ensure more caregivers participate.

Support integration and coordination of different services and programs

A centralized agency should oversee and coordinate federal efforts to support military nurses. Currently, four agencies-the Department of Health and Human Services, the Department of Labor, the Department of Veterans Affairs, and the Department of Defense-directly or indirectly support this population.

Although there is some evidence of interdepartmental cooperation, gaps and inconsistencies remain in eligibility criteria and program definitions. Efforts to facilitate interagency coordination, such as through interagency working groups or federal task forces and commissions, could improve the harmonization and quality of support services for military nurses.

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